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Complex neurological infections require team care

Comprehensive guidelines for diagnosis, treatment and prevention of healthcare-associated ventriculitis and meningitis

Date:
February 16, 2017
Source:
Infectious Diseases Society of America
Summary:
A multidisciplinary approach is important for diagnosis and treatment of healthcare-associated ventriculitis and meningitis, suggest new guidelines. These complex brain and spinal infections can be deadly or cause permanent disability if they are not identified early and treated correctly. The guidelines suggest how such infections can be prevented, including the use of prophylactic antimicrobial agents during placement of the devices.
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A team approach is vital to the successful diagnosis and treatment of complex neurological infections related to placement of devices in the brain, or as a result of neurosurgery or head trauma. This is among the recommendations in the first comprehensive guidelines on healthcare-associated ventriculitis and meningitis, which are being released by the Infectious Diseases Society of America (IDSA) and published in the journal Clinical Infectious Diseases.

"These complicated infections affect the central nervous system and can lead to death and permanent disability if not recognized and managed appropriately," said Allan R. Tunkel, MD, PhD, lead author of the guidelines and professor of medicine and associate dean for medical education at Warren Alpert Medical School of Brown University, Providence, R.I. "While other guidelines have addressed infections in specific circumstances, these provide more comprehensive guidance to physicians of various specialties who care for these complex patients."

The guidelines provide parameters regarding when clinicians should consider the possibility of ventriculitis (inflammation of the ventricles in the brain) or meningitis (inflammation of the lining of the brain or spinal cord) in patients who have cerebrospinal fluid shunts and drains (devices placed in the brain to relieve pressure due to fluid buildup), intrathecal drug pumps (for administration of pain medicine or other drugs into the spinal canal), deep brain stimulation hardware (medical devices that provide electrostimulation in the brain to treat Parkinson's disease or other neurological symptoms) or who have undergone neurosurgery or suffered from head trauma. Due to the complexity of these infections, they need to be managed by a multidisciplinary team most often featuring infectious diseases (ID) specialists, neurologists, neurosurgeons and neurocritical care specialists, Dr. Tunkel said.

The guidelines help clinicians determine when to suspect ventriculitis or meningitis and start patients on appropriate antimicrobial therapy while awaiting culture results to confirm the infection and organism causing it. Vancomycin typically is the recommended antimicrobial agent of choice while clinicians await culture results, due to its success at combating the staphylococcus bacteria (a common cause of these types of infections); another antimicrobial agent is also added to treat other potential organisms. Additionally, the guidelines recommend when a device should be removed and replaced.

The guidelines also delve into various ways these infections may be prevented, such as using prophylactic antibiotics during placement of the devices, as well as employing "practice bundles," specific steps neurosurgeons should take when placing shunts and drains.

"Specialists must work together to ensure proper management of these patients, which is critically important to improving outcome," said Dr. Tunkel. "These guidelines offer currently available evidence for treating these infections, but physicians need to use individual judgement based on how patients are responding to therapy."


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Materials provided by Infectious Diseases Society of America. Note: Content may be edited for style and length.


Journal Reference:

  1. Allan R. Tunkel, Rodrigo Hasbun, Adarsh Bhimraj, Karin Byers, Sheldon L. Kaplan, W. Michael Scheld, Diederik van de Beek, Thomas P. Bleck, Hugh J.L. Garton, Joseph R. Zunt. 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*. Clinical Infectious Diseases, 2017; DOI: 10.1093/cid/ciw861

Cite This Page:

Infectious Diseases Society of America. "Complex neurological infections require team care: Comprehensive guidelines for diagnosis, treatment and prevention of healthcare-associated ventriculitis and meningitis." ScienceDaily. ScienceDaily, 16 February 2017. <www.sciencedaily.com/releases/2017/02/170216103907.htm>.
Infectious Diseases Society of America. (2017, February 16). Complex neurological infections require team care: Comprehensive guidelines for diagnosis, treatment and prevention of healthcare-associated ventriculitis and meningitis. ScienceDaily. Retrieved May 26, 2017 from www.sciencedaily.com/releases/2017/02/170216103907.htm
Infectious Diseases Society of America. "Complex neurological infections require team care: Comprehensive guidelines for diagnosis, treatment and prevention of healthcare-associated ventriculitis and meningitis." ScienceDaily. www.sciencedaily.com/releases/2017/02/170216103907.htm (accessed May 26, 2017).

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